Reducing patient-staff contact in fast-track total hip arthroplasty has no effect on patient-reported outcomes, but decreases satisfaction amongst patients with self-perceived complications: analysis of 211 patients.

BACKGROUND AND PURPOSE: Several studies have compared fast-track with conventional pathways for total hip arthroplasty (THA) patients, but none have compared different fast-track pathways. Due to COVID-19 restrictions, our department had to minimize patient-staff contact in the THA pathway. First, telephone consultations were implemented instead of an outpatient clinic visit and subsequently preoperative patient education was discontinued. This enabled us to compare patient-reported outcomes and satisfaction among 3 fast-track pathways. PATIENTS AND METHODS: We collected data from patients treated for hip osteoarthritis with THA at Gødstrup Hospital between 2018 and 2021. The patients had experienced 1 of 3 pathways and were interviewed via telephone between 2 and 6 months after discharge. We analyzed the influence of patient pathway on patient-reported pain and mobility level, self-perceived complications, and compliance using logistic regression. We then compared the pathway's effect on patient satisfaction both for the total sample and for the patients who experienced complications. RESULTS: The amount of patient-staff contact in the patient pathway did not have any influence on patientreported outcomes or the probability of self-perceived complications. For the full sample, patient-staff contact had no statistically significant influence on patient satisfaction either, but for the subgroup of patients experiencing complications, the pathways with less patient-staff contact reduced satisfaction. Patient satisfaction was primarily related to pain and mobility outcomes. INTERPRETATION: Our results indicate that reducing patient-staff contact in fast-track THA can be done without influencing mobility and pain outcomes, but the overall satisfaction among patients with self-perceived complications will be negatively affected.

The rural happiness paradox in developed countries.

In this paper, a national Danish survey is used to explore the rural happiness paradox in developed countries. This paradox revolves around the observation that rural residents tend to report higher subjective well-being than urban residents in developed countries. Based on three different rural-urban classifications, the paper provides a solid confirmation of the rural happiness paradox in Denmark. The paper tests three hypotheses regarding the factors behind the rural happiness paradox and finds strong support for two of the hypotheses. Thus, higher bonding social capital in rural areas and higher access to nature amenities in rural areas were found to contribute to the rural happiness paradox in Denmark. As for the third hypothesis, the paper finds no significant evidence that rural-urban differences in spatial location satisfaction (measured by the correspondence between actual and preferred residential location on the rural-urban continuum) contribute to the rural happiness paradox in Denmark.

The potential migration effect of rural hospital closures: a Danish case study.

AIMS: Rural hospital closures are high on the current healthcare agenda in Denmark. One concern raised is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to healthcare services elsewhere. The aim of this study was to investigate whether rural hospital closures may lead to out-migration in a Danish setting and to investigate which socioeconomic groups would be most likely to migrate. METHODS: The island of AErø was selected as the case study area. The island has one small hospital. By the use of fully structured telephone interviews, a representative sample of AErø inhabitants (N=1000) was asked how important it was for them to live close to a hospital and whether they would consider moving away if their hospital was closed. RESULTS: Forty-seven per cent found it very important to live close to a hospital, and 29% would consider moving away if their hospital was closed. Multiple regression analyses showed that families with children were most likely to consider moving away and elderly people were least likely to consider moving away. CONCLUSIONS: The study suggests that rural hospital closures may lead to out-migration, although the hypothetical method of questioning leaves uncertainty about the actual scale of out-migration. Families with children appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on healthcare and least inclined to move away.

Attitudes toward telehealth use among rural residents: a Danish survey.

CONTEXT: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health care by means of telehealth is the existence of positive attitudes toward telehealth solutions among the potential end beneficiaries. PURPOSE: The purpose of this study was to examine the attitudes toward telehealth use among residents in a Danish rural area. METHOD: A representative sample from the island of AErø (n = 1,000) was selected and attitudes toward 2 telehealth applications were examined by structured telephone interviews regarding: (1) video consultation between patient and specialist, and (2) transfer of work tasks from local hospital to a hospital outside Denmark. FINDINGS: As many as 58% did not like the idea of having a consultation with a specialist carried out by video consultation, whereas 26% did not like the idea of having their X-rays assessed by a hospital outside Denmark. The reluctance regarding both telehealth solutions was higher among older people and people with no education beyond primary school. CONCLUSIONS: As the rural population in Denmark, as well as in other countries, tends to be older and less educated than the national average, the introduction of telehealth services faces special challenges in rural areas.

Working conditions in international seafaring.

BACKGROUND: Seafaring is a global profession and seafarers have their second home on board and live there for several months at a time. AIM: To assess self-rated health status and the main characteristics of seafarers' working conditions. METHODS: Questionnaire study concerning the most recent tour of duty. RESULTS: A total of 6,461 seafarers in 11 countries responded. In general, the seafarers' self-rated health was good, but it declined significantly with age. Seafarers from South-East Asian countries spent longer time periods at sea, and had lower numbers of officers and older seafarers than found among seafarers from western countries. Most seafarers worked every day of the week, and on average for 67-70 h a week during periods of 2.5-8.5 months at sea. CONCLUSIONS: Seafarers' self-rated health was generally good but varied significantly by country. Working conditions also differed by country but did not reflect working conditions in general. Further studies are necessary to describe more closely the influence of work schedules on the health and social life of seafarers.

Self-reported injuries among seafarers. Questionnaire validity and results from an international study.

International surveys of occupational injuries among seafarers have so far been missing. It was the aim to test the method of self-report of injuries and length of time at risk during the latest duty period and second to study the injury incidence rate among seafarers by use of the method. A pilot study was conducted (n = 1068) in Finland, Denmark, the Philippines, Croatia and Spain using self-completed questionnaires with questions about the person, the ship, the duration of latest duty period and injuries. The duration of the self-reporting duty period was in the Danish part compared with information from the crew register of the Maritime Authority. For seafarers from merchant ships in the Danish sub-study there was acceptable correspondence between the information from the seafarers and the Maritime Authority, but not when referring to ferries and non-specified types of ship. Unadjusted and adjusted injury incidence rates-ratios (IRRs) based on number of injuries per number of work hours were calculated. Adjusted IRRs for ordinary seamen/officers: IRR = 2.43 (95% CI: 1.25-4.72); for age < 35/35+ years: IRR = 1.97 (1.02-3.81); length of tour: 117 days or longer compared with < 117 days: IRR = 0.46 (95% CI: 0.22-0.95); 57-70 working hours per week compared with < 57 h: IRR = 1.26 (0.48-3.29), 71+h compared with < 57 h: IRR = 2.12 (0.84-5.36). Non-significant IRRs >1.00 were found for ships under 10,000 GT compared with larger ships and for own flagged ships compared with ships under flag of convenience. In conclusion, more than 70 h of work per week was related to a higher rate of injuries for seafarers on merchant ships, but the result was not statistically significant. Self-report of the duration of the latest tour of duty is useful for seafarers from merchant ships with short-term employments, but not for ferries and other, non-specified types of ship with other or permanent employment.